Kadhum M, Smock E, Khan A, Fleming A
1 St George's University of London, London, UK.
2 Plastic and Reconstructive Surgery, St Georges Hospital NHS Trust, London, UK.
J Hand Surg Eur Vol. 2017 Sep;42(7):689-692. doi: 10.1177/1753193417695996. Epub 2017 Mar 13.
Radiotherapy has been advocated as an alternative treatment in early Dupuytren's disease. We have systematically reviewed the evidence on the use of radiotherapy in Dupuytren's disease. Only six articles met a minimum set standard, five of which were retrospective cohort studies and one a randomized controlled study. A total of 770 Dupuytren's hands, nearly all with Tubiana stage 0-1 disease, were irradiated with an average 30 Gy. Disease regression ranged from 0%-56%, stability from 14%-98% and progression from 2%-86%. Salvage surgery was successful in all cases of disease progression post-radiotherapy. There were no reports of adverse wound healing problems associated with such surgery or radiotherapy-associated malignancy. On balance, radiotherapy should be considered an unproven treatment for early Dupuytren's disease due to a scarce evidence base and unknown long-term adverse effects. Well-designed randomized controlled studies are required to confirm the benefits of radiotherapy treatment.
II.
放射疗法已被提倡作为早期掌腱膜挛缩症的一种替代治疗方法。我们系统回顾了掌腱膜挛缩症使用放射疗法的证据。仅有6篇文章符合最低设定标准，其中5篇为回顾性队列研究，1篇为随机对照研究。总共770只患掌腱膜挛缩症的手，几乎所有处于蒂比阿纳0 - 1期疾病，平均接受30 Gy的照射。疾病消退率为0% - 56%，稳定率为14% - 98%，进展率为2% - 86%。补救手术在放疗后所有疾病进展的病例中均成功。没有关于此类手术或放疗相关恶性肿瘤导致的伤口愈合不良问题的报告。总体而言，由于证据基础稀缺且长期不良反应未知，放射疗法应被视为早期掌腱膜挛缩症的一种未经证实的治疗方法。需要设计良好的随机对照研究来证实放射治疗的益处。
II。
